Blood pressure lowering efficacy of reserpine for primary hypertension
Editorial Group: Cochrane Hypertension Group
Published Online: 7 OCT 2009
Assessed as up-to-date: 11 AUG 2009
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Shamon SD, Perez MI. Blood pressure lowering efficacy of reserpine for primary hypertension. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007655. DOI: 10.1002/14651858.CD007655.pub2.
- Publication Status: New
- Published Online: 7 OCT 2009
Many antihypertensive agents exist today for the treatment of primary hypertension (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg). Randomised controlled trials have been carried out to investigate the evidence for these agents.There is, for example, strong RCT evidence that thiazides reduce mortality and morbidity. Reserpine has been used as a second-line therapy in some of those trials. However, the dose-related blood pressure reduction with this agent is not known.
To investigate the dose-related effect of reserpine on blood pressure, heart rate and withdrawals due to adverse events.
The databases CENTRAL, EMBASE, and MEDLINE were searched. We also traced citations in the reference sections of the retrieved studies.
Included studies were truly randomised controlled trials comparing reserpine monotherapy to placebo or no treatment in patients with primary hypertension.
Data collection and analysis
Methods of randomization and concealment were assessed. Data on blood pressure reduction, heart rate,and withdrawal due to adverse effects were extracted and analysed.
Four RCTs (N =237) were found that met the inclusion criteria. The overall pooled effect demonstrates a statistically significant systolic blood pressure (SBP) reduction in patients taking reserpine compared to placebo (WMD -7.92, 95% CI -14.05, -1.78). Due to significant heterogeneity across trials, a significant effect in diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) could not be found. The SBP effects were achieved with 0.5 mg/day or greater. However, the dose-response pattern could not be determined because of the small number of trials. Data from the trial that investigated Rauwiloid against placebo was not combined with reserpine data from the remaining three trials. This is because Rauwiloid is a different alkaloid extract of the plant Rauwolfia serpentina and the dose used is not comparable to reserpine. None of the included trials reported withdrawals due to adverse effects.
Reserpine is effective in reducing SBP roughly to the same degree as other first-line antihypertensive drugs. However, we could not make definite conclusions regarding the dose-response pattern because of the small number of included trials. More RCTs are needed to assess the effects of reserpine on blood pressure and to determine the dose-related safety profile before the role of this drug in the treatment of primary hypertension can be established.
Plain language summary
Reserpine, an old and almost forgotten antihypertensive drug, lowers blood pressure
Reserpine, a root extract of the naturally occurring plant Rauwolfia serpentina, was used in the past as first-line therapy for reducing blood pressure. Nowadays, it is used mainly as a second line agent. This review, which aimed to find and summarize existing evidence from randomised controlled trials, concluded that reserpine is effective in reducing systolic blood pressure as a first-line agent. The degree of this effect was mild to moderate. Because the four included studies did not investigate a wide range of doses, no data was available to infer a dose-related response in blood pressure. Insufficient data was available to evaluate the adverse effects of reserpine therapy.
四個隨機對照試驗(病人數237人)符合納入標準。在彙總此四研究結果之後，顯示服用reserpine病人收縮壓的降低比安慰劑組有統計學上的意義(加權平均差異(WMD) −7.92, 95%信賴區間−14.05, −1.78)。因為此四組隨機對照試驗間差異性顯著，我們無法得出reserpine比起對照組是否對舒張壓、平均動脈壓、及心率產生統計學上顯著的差異。每天0.5毫克或更大的劑量即可達成對收縮壓的效果。然而，因為這些研究的樣本數太少，我們無法找出劑量性與血壓下降量間的關係。我們也沒有比較Rauwiloid與安慰劑效果組之研究結果併入其他三組研究reserpine的結果。這是因為Rauwiloid是從印度蛇木(Rauwolfia serpentina)萃取出來的一個不同的植物鹼，因此其所使用之劑量無法與reserpine比較。這四組研究均沒有因不良藥物反應而停藥的個案報告。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。